Emotion Regulation Mediates the Relationship Between ACES and Physical and Mental Health

Objective: Adverse Childhood Experiences (ACEs) have consistently been associated with a range of negative psychological and physical outcomes in adulthood. Despite the strength of this association, no studies to date have investigated psychological processes that might underlie this relationship. The current study evaluated emotion regulation as a potential mediator between ACEs and three outcomes: PTSD symptoms, depression and poor physical health, all of which are frequently co-occurring among women with ACEs. Method: Mediational analyses were conducted with baseline data from a sample of 290 women enrolled in a clinical trial for PTSD. Emotion regulation was assessed with the Difficulties in Emotional Regulation Scale (DERS), PTSD with the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), depression with the Brief Symptom Inventory Depression subscale (BSI-D) and physical health with a shortened version of Medical Outcomes Study Short Form (SF-8). Results: Emotion regulation significantly mediated the relationship between ACEs and all three outcomes. The estimates of the standardized indirect effects of ACEs on the health outcomes as mediated through DERS scores were as follows: PTSD beta = 0.1, p < .001; depression beta = 0.16, p < .001; physical health beta = 0.07, p = .002. Conclusion: Interventions that focus on improving emotion regulation skills might provide an efficient "transdiagnostic" treatment strategy for both psychological and physical health problems. The study successfully tested a mediational model that identified a common pathway influencing both mental and physical health symptoms.